Earlier and enhanced rehabilitation of mechanically ventilated patients in critical care: A feasibility randomised controlled trial

Background: Systematic reviews of early rehabilitation within intensive care units have highlighted the need for robust multi-centre randomised controlled trials with longer term follow up. This trial aims to explore the feasibility of earlier and enhanced rehabilitation for patients mechanically ventilated for ≥ 5 days and to assess the impact on possible long term outcome measures for use in a definitive trial. Methods: Patients admitted to a large UK based intensive care unit and invasively ventilated for ≥ 5 days were randomised to the rehabilitation intervention or standard care on a 1:1 basis, stratified by age and SOFA score. The rehabilitation intervention involved a structured programme, with progression along a functionally based mobility protocol according to set safety criteria. Results: 103 out of 128 eligible patients were recruited into the trial, achieving an initial recruitment rate of 80%. Patients in the intervention arm mobilized significantly earlier (8 days vs 10 days, p = 0.035), at a more acute phase of illness (SOFA 6 vs 4, p < 0.05) and reached a higher level of mobility at the point of critical care discharge (MMS 7 vs 5, p < 0.01). Conclusion: We have demonstrated the feasibility of introducing a structured programme of rehabilitation for patients admitted to critical care.